Alleviating hidden hunger: an infallible bridge to improved health and nutrition
Authors: Jai K Das, Zahra Ali Padhani
Journal: The Lancet Global Health (2022)

Micronutrient deficiencies, a synonym of hidden hunger,1Muthayya S Rah JH Sugimoto JD Roos FF Kraemer K Black RE The global hidden hunger indices and maps: an advocacy tool for action.PLoS One. 2013; 8e67860Crossref PubMed Scopus (295) Google Scholar is a form of malnutrition that occurs due to low intake and absorption of micronutrients and vitamins, such as iron, iodine, zinc, and vitamin A. Such deficiencies affect sustained good health, including physical and cognitive bodily functions. The impairments caused by micronutrient deficiencies might be initially unnoticeable but can advance to significant implications and sometimes irreparable losses. Children, adolescents, and pregnant women are at a greater risk, as the demands during these stages of life are higher. The effects include but are not limited to poor growth and cognitive development, anaemia, night blindness, osteoporosis, cardiovascular diseases, and even cancers.2Keats EC Das JK Salam RA et al.Effective interventions to address maternal and child malnutrition: an update of the evidence.Lancet Child Adolesc Health. 2021; 5: 367-384Summary Full Text Full Text PDF PubMed Scopus (133) Google Scholar These undesired consequences can lead to far-reaching implications and affect the development potential of individuals through reduced educational gains and work productivity, and ultimately hinder the development of societies and nations.2Keats EC Das JK Salam RA et al.Effective interventions to address maternal and child malnutrition: an update of the evidence.Lancet Child Adolesc Health. 2021; 5: 367-384Summary Full Text Full Text PDF PubMed Scopus (133) Google Scholar In The Lancet Global Health, Gretchen Stevens and colleagues3Stevens GA Beal T Mbuya MNN et al.Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: a pooled analysis of individual-level data from population-representative surveys.Lancet Glob Health. 2022; 10: e1590-e1599Summary Full Text Full Text PDF PubMed Scopus (59) Google Scholar provide an update on the global burden of micronutrient deficiencies. The previously used estimate was generated three decades ago and based solely on anaemia. Stevens and colleagues reanalysed and pooled global individual-level data on micronutrient status biomarkers from 24 nationally representative, population-based surveys of 22 countries between 2005 and 2019. Stevens and colleagues estimate that, globally, 56% (95% uncertainty interval 48–64) of preschool-aged children and 69% (59–78) of non-pregnant women of reproductive age are deficient in at least one micronutrient. This equates to around 372 million preschool-aged children and 1·2 billion non-pregnant women of reproductive age deficient in one of the key micronutrients, which are iron, zinc, and vitamin A in preschool-aged children, and iron, zinc, and folate in non-pregnant women of reproductive age. Although no world region is spared from this burden, including high-income countries, the burden is unequivocally high in south Asia, sub-Saharan Africa, and east Asia and the Pacific for preschool-aged children, and in east Asia and the Pacific and south Asia for non-pregnant women of reproductive age. These estimates are likely to be an underestimate as the study did not assess deficiencies of all key micronutrients, and the true global burden in numbers would be much higher if we include all population groups. There is a need for population-representative surveys for key micronutrient at the national level, and to have representative subnational data to better understand the context of micronutrient deficiencies and to tailor specific strategies for specific micronutrients, specific populations, and specific regions. Robust studies would be needed with standardised assays, cutoff values, and laboratory methods along with adjustment for inflammation. The world has been engulfed with micronutrient deficiencies for decades now and although multiple strategies and programmes have been implemented by national and international communities, they have been incapable of tackling this in a holistic and sustainable manner. And with the rapidly changing climate and ensuing draughts, water scarcity, unpredictable rain patterns, floods, and reduced agriculture output, there could be greater poverty and food insecurity,4Ali S Liu Y Ishaq M et al.Climate change and its impact on the yield of major food crops: Evidence from Pakistan.Foods. 2017; 6: 39Crossref Scopus (256) Google Scholar, 5Food and Agriculture Organization of the United NationsClimate change and food security: risks and responses. Food and Agriculture Organization of the United Nations, Rome2015Google Scholar, 6Kumar P Tokas J Kumar N Lal M Singal HR Climate change consequences and its impact on agriculture and food security.Int J Chem Stud. 2018; 6: 124-133Google Scholar most likely raising the existing burden. There are several acceptable approaches for improving micronutrient status, including dietary diversification strategies, fortification and biofortification, and micronutrient supplementation. Specific context-specific tailored solutions are needed, not only to ensure nutrients but also to ensure acceptability and sustainability. Further research is needed on how these micronutrients and vitamins could be enriched in local foods, which would ensure greater reach, acceptability, and sustainability. Thus, the international nutrition community needs to partner with cross-sectoral communities and the governments of individual countries together with funding agencies to come up with plausible, innovative, and local context-specific solutions to resolve micronutrient deficiencies and contribute to achieving the Sustainable Development Goals.7Heidkamp RA Piwoz E Gillespie S et al.Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: an agenda for action.Lancet. 2021; 397: 1400-1418Summary Full Text Full Text PDF PubMed Scopus (86) Google Scholar The long-pending challenges of malnutrition together with climatic changes and with escalating conflict and humanitarian disasters, the world needs to accelerate progress across all areas of nutrition, and reform the structures and systems with ensuring financing stability for nutrition together with handling the underlying factors. We declare no competing interests. Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: a pooled analysis of individual-level data from population-representative surveysWe estimate that over half of preschool-aged children and two-thirds of non-pregnant women of reproductive age worldwide have micronutrient deficiencies. However, estimates are uncertain due to the scarcity of population-based micronutrient deficiency data. Full-Text PDF Open Access